Injury Clinic

Complex Fracture Repair - Michelle Mason

Michelle Mason at first couldn’t believe the injury she sustained when she fell at work. A nurse who works in a family practitioner’s office in central Illinois, Mason suffered a seizure and passed out. When she awoke, she realized something was terribly wrong.

“I saw my ankle flopping around and I was in a lot of pain,” Mason recalls. “I had to go by ambulance to a local hospital and the doctors there sent me immediately to Barnes-Jewish Hospital because of the severity of the fracture.”

Mason, in fact, had a complex spiral fracture of her right tibia that extended down into her ankle. A spiral fracture occurs when a bone is twisted or torqued in one direction and subsequently fractures from the force, causing extreme pain.

Orthopedic surgeons at Washington University School of Medicine first realigned Mason’s tibia as much as possible and then used a surgical rod and several screws to hold the bone in place. The inserted rod was placed down the middle of the tibia to stabilize the bone.

“I couldn’t walk on it at all, so I wasn’t able to go to work,” says Mason. “That was really hard because I’m one of those people who always worked hard, coming in early and staying late.”

Tibia fractures are difficult to repair, primarily because this bone can have limited healing capacity. Tibia fractures are notorious for being slow to heal. In many cases, the severity of the fracture, coupled with its location, makes recovery a multi-stage process. Bone has the ability to regenerate during standard fracture repair. In more complex cases, however, bone regeneration sometimes stalls.

“In this case, we had to take out the old rod three months later and do a roto-router type of procedure in which we ream or scrape the inside of the tibia to stimulate bone growth,” explains William Ricci, MD, Chief of Orthopaedic Trauma. Ricci has long-standing expertise in the treatment of both complex fractures and nonunions, which occur when the bone fails to heal completely.

“When a nonunion occurs, there has to be very individualized treatment,” says Ricci. “We have to first investigate why the nonunion occurred, which could be the result of medical conditions such as the use of certain medications, smoking, diabetes or even a vitamin D deficiency. It could also be the result of not enough bone regeneration because of the complex nature of the fracture.”

For fractures that don’t heal properly, a bone graft could be the next step. Grafts are made by obtaining thin shavings of bone from either another location on the patient’s body or from donated bone. Mason’s graft was taken from her iliac crest, the upper portion, or wingbone, of the pelvis.

“The bone shavings are the consistency of soft shaved ice,” Ricci says. “We pack that material into the defects left in the bone, sort of like spreading spackling, and it hardens over six to 12 weeks. Over time, the bone graft becomes integrated with the existing bone, thereby healing the fracture.”

“That did the trick,” says a relieved Mason. “It was a long process and I was in and out of the hospital three times, but Dr. Ricci explained everything to me and told me it would take a while to heal.”

After extensive physical therapy, Mason is now almost fully recovered. “I went a little batty because I couldn’t do a whole lot while the leg was healing,” she says. “But I can now walk and drive and go on road trips with the family. It’s so much better now.”